Day in the Life of an Oncology Fellow

When my alarm goes off at 5:30 am, I wake up prepared to play many roles. Juggling family life with 2 young children, caring for my patients as a fellow, and pursuing scholarly activities leaves little free time. One of the joys of being a fellow at an academic institution is that I really do not have a “typical” day. Each workday brings a different combination of patient care and research, both of which can be challenging and exciting.

By 7 am, there has already been a lot of activity in my home. Changing diapers, feeding bottles, and searching for my elder daughter’s favorite pink dress consume my early morning. Afterward, I rush to work so that I arrive on time for rounds.

If I’m on an inpatient service, by 7:30 am my rounds are starting. The residents and interns are busy gathering patients’ vital signs and orders, and I am preparing chemotherapy orders. As a fellow on rounds, I enjoy leaving issues such as uncomplicated diabetes and hypertension to the internal medicine residents while I focus on the oncologic care of the patient. After our attending hurries off the wards to clinic, I am in charge of the service and our patients. Most days on service I spend much of the morning going over plans with the residents and—most importantly—teaching the students what they must know about our oncology patients. I try to focus less on specific chemotherapeutics, which I am still learning myself, and more on treatment of complications and communication with patients. Even though I am still acquiring these skills, one of the most useful things I can teach the students is how to deliver difficult news to our patients. Medical schools and residency programs do an excellent job of teaching facts, treatment algorithms, and disease management, but the oncology ward is the ideal place for students to learn the art of communication.

If I am the hematology or oncology consult fellow during a given month, by 7:30 am my pager has already gone off a couple of times. In my experience, the busiest times in fellowship are consult services, when you never seem to be in enough places at once. On the positive side, however, this fast-paced work helps me learn the most about a wide variety of cases.

If I am not on service, which is typical now that I am a senior fellow, my morning is somewhat more relaxing. After many months of busy service as a first-year fellow, when I became a senior fellow I welcomed the opportunity to do clinical research in the comfort of my office. I can now spend my time reading and focusing on GI research. More specifically, I am working on a review article about pancreatic cancer and a clinical protocol for neuroendocrine cancers. I’m always working on multiple projects at once in hopes that at least some get published, or funded in the case of a grant. Even as a senior fellow, it is easy to be caught up in patient care at the hospital because there is always a need for a bone marrow biopsy, intrathecal chemotherapy, or orders to be written. It’s very important, though, that I make enough time to pursue scholarly activities that will help me in my career and to become a better oncologist.

By noon, I have left the residents to manage the oncology service and I squeeze in a lecture. As a fellow, finding time to attend a lecture is a daily struggle. Between clinical work and research, it is very tempting to skip it so that I can catch up on work. Most days I do try to avoid this temptation, as the lectures are essential to my learning as a fellow.

After a quick bite to eat, it’s off to clinic for the remainder of the afternoon. Now that I’ve been in clinic for a couple of years, the patients are familiar to me because I’ve had the opportunity to follow many of them as they progress through their treatment. Although my attending is in clinic with me, many of my patients now view me as their oncologist. Each afternoon in clinic is usually a mix of emotions as I share both good and bad news with them. It is not uncommon that in 1 hour of clinic I have rejoiced with one patient at the completion of her chemotherapy course and in the next visit have consoled another after learning that his malignancy has recurred. For me, each of these encounters is equally fulfilling, and I always leave clinic feeling privileged to have shared in these experiences with my patients, whether joyful or sad.

By 5 pm, although I am tired, I am excited about one of the best parts of my day. After finishing at least some of my clinic notes, I hurry down the street to pick up my kids from day care. The look on their faces when they see me is always reenergizing and is a much-needed break from the hospital. Although sometimes it is impossible, I try not to do any more work when I am at home. During fellowship, the time with my husband, kids, and friends is a precious thing. My evenings consist of tea parties with my daughter, rocking my son to sleep, and catching up with my husband. I have to admit that it is not always easy balancing my family with fellowship. It is difficult to completely keep family life and work separate in oncology because many of our patients depend on us even when it is not between the hours of 8 am and 5 pm. Although I value keeping my family life the highest priority, I also hope that the dedication and time commitment I have shown to my patients and research will be a good example for my children.

By the end of the evening, fatigue has set in and I begin to prepare for the next day. There is always a recent article or textbook chapter to be read that oftentimes needs to wait until the next day. My clinic notes need to be finished too, but they will also need to wait until the next day. The beauty of oncology training is that tomorrow will offer new challenges to find enough time in the day as well as opportunities to learn more about how best to help our patients.